Provider Demographics
NPI:1659505774
Name:SU, XIAO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:XIAO
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1090
Mailing Address - Country:US
Mailing Address - Phone:518-587-3222
Mailing Address - Fax:
Practice Address - Street 1:3 CARE LN STE 300
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8636
Practice Address - Country:US
Practice Address - Phone:518-226-6000
Practice Address - Fax:518-226-6001
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY253733207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program